• Forever Bare Electrolysis

    New Client Forms
  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • How did you find Forever Bare Electrolysis?*
  • If referred, who referred you?
  • Have you had electrolysis before ?*
  • Are you currently under a physician's care?*
  • If yes, for what reason?
  • Are you currently taking any prescribed medication?*
  • If yes, please list.
  • Are you currently taking any oral or topical medications like Accutane, Retin-A, or other retinoids for your skin? *
  • Do you regularly get Botox, fillers, facials, or other skin treatments?*
  • Do you wax, tweeze, or thread the area ?*
  • If so, how often?
  • Have you had laser treatments?*
  • If so, when was your last treatment?
  • Please check the area or areas you are interested in treating.*
  • Do you have or take any of the following? If yes, please check the box.*
  • By checking each box you ensure you have read, understood, and agreed to the following:*
  • Pictures are a great way to keep track of results. Do you give Forever Bare Electrolysis permission to take photos for tracking and marketing purposes? No personal or identifying information will be included on any marketing platforms.*
  • Should be Empty: